"There are potential risks involved," Caine said. "And the things we talk about with them are fertility. So if someone starts using testosterone to masculinize, it's not clear what the long-term effects that has on fertility."

Caine also counsels on risks and benefits transitioning to a body transgender teens feel is more authentic to who they are are inside.

Youth Outright is where Rori, Eli and Jackson have found a second family. They support each other if they face rejection at school or at home.

"If they don't have support in those places, then having this can save a life," Laurie Pitts, a volunteer and one of the counselors involved in the group, said. "Having friends makes a huge difference."

Parents, the teens said, can be the toughest ones to tell. But Jackson had this advice for any parent with a teen struggling with gender identity.

"No matter how your teen identifies, it might not be a phase, and you should respect that," Jackson said. "They came to you and told you, and so you should trust them with the journey."